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Initial/ Renewal Reciprocity Application

8669 NW 36 St, #130 Miami, FL 33166-6672 CWB/ICWI to CWI


(800) 443-9353 extension 273
Faxed or emailed applications are NOT accepted
AWS Membership # ____________________________
Last Name First Name MI

Address (contd) Apt #

City and State / Province / Country Zip Code

Home Telephone Number Work Telephone Number Mobile Telephone Number

E-Mail Address (confirmation notification will be sent to this address)

Date of Birth (example November 30 1952)

Month Day Year

1. Choose one
1st Time Reciprocity Reciprocity Renewal CWI Certification # ___________________________ Expiration Date ______________
CWB Applicants: Attach a copy of your CWB card with a current expiration date confirming your certification to Canadian Standard CSA W178.2.
ICWI Applicants: Attach a copy of your ICWI card with a current expiration date confirming you successfully passed the INWC examination
2. Visual Acuity Record
A current Visual Acuity Record must be completed and submitted with this application. To download a copy of the form, visit our website.
3. Photo Requirement
Applicants MUST submit one (1) passport-style color photograph. Your photo is a vital part of your application. To learn more, review the
information on how to provide a suitable photo to avoid processing delays by visiting our website. The acceptance of your photo is always at the
discretion of the AWS.
Print your name and AWS membership number on the reverse of the photograph.

Photos copied or digitally scanned from


drivers licenses or other official documents
are not acceptable.

Print your name and AWS membership


number on the reverse of the photograph.

Only use scotch tape on the back of the


photo.

4. Method of Payment Fees AWS USE ONLY


Payment must accompany this application. AWS Bank Information - All checks,
Demand Drafts and money orders must be drawn against banks in U.S.A., payable in
American Dollars and made payable to American Welding Society. Acct #: ___________________________________

Check or money order #_______________________

VISA MC AMEX Discover Date: ____________________________________

CC#: / / / Exp: /
Amt $: ___________________________________
SIGNATURE:_________________________________________________________ CVV:______________________

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Name ________________________________________________ AWS Member # _________________________________
5. Testimonial
Certified Welding Inspector
QC1 Standard for the AWS Certification of Welding Inspectors
B5.1 Specification for the Qualification of Welding Inspectors

Applicants must read and sign the following statement in front of a notary
I hereby certify that I have read the standard requirements contained in the certification programs indicated above. Further, I agree
to comply with the existing requirements and any subsequent requirements that may be instituted by AWS. I have read and agree
to the terms and conditions set forth in the AWS Policies and Fees form. I certify that the information I have included on this
application is true. I understand that any false statements will nullify this application. I give AWS permission to verify this
information. I agree to comply with the provisions set forth in the Standard concerning the administration of my examination and
certification. Upon obtaining my certification, I give AWS the right to reveal my certification status as it relates to my validity and
expiration date only. I further understand that any required information that is incomplete or missing will cancel this registration.
Furthermore, I certify that I have not obtained or shared any exam materials, have no prior knowledge of the AWS exam
questions or answers, and have not and will not accept any solicitation for the AWS exam questions or answers from anyone at
any time before or after the exam. I understand that a violation of this oath may be grounds for invalidation of my certification.

Applicants Signature ______________________________________________________ Date _________________________

The following is to be completed by A Notary Public

Sworn to and subscribed before me this __________ day of ___________________ 20 _____ .

My commission expires _________________________________________________________

Notary Public Signature _________________________________________________________ NOTARY STAMP


AND/OR SEAL IS REQUIRED

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